Shattuck, P.T., Seltzer, M.M, Greenberg, J.S., Orsmond, G.I., Bolt, D., Sring, S., Lounds, J., & Lord, C. (2007).  Change in autism symptoms and maladaptive behaviors in adolescents and adults with an autism spectrum disorder.  JADD, 37, 1735-1747.  DOI on paper.

• ASD - affects multiple domains and is lifelong
• little research of the progression of symptoms across time
  • especially maladaptive behaviors
• present study - autism symptoms and problem behavior in adolescents and adults with autism
  • community sample
  • prevalence
  • predictors for
    • looking at the specific core diagnostic symptoms
    • literature - tendency towards improvement (Seltzer et al 2003)
    • ususally use ADI-R scores (would be interested in seeing if ADOS would be more precise)
    • articles of interest
      • Fecteau, Mottron, Berthiaume, Burak, 2003, McGovern & Signman 2005,
    • age predictor of change
• seems to be three other predictors of change
  • MR
  • language
  • gender - mixed results
  • Lord & Bailey, 2002, Shea & Mesibov, 2005
• prevalence and change in maladaptive behavior - adolescence and adulthood
  • little research
  • autism - higher levels of problem behavior what those with other genetic or or no other disability (Tonge & Einfeld, 2003)
  • decline in problem behavior across longitudinal studies
    • autism - more aggression, disruption, SIB than other types of disabilities
    • McClintock, Hall & Oliver, 2003; Lecavalier, 2005
• hypotheses
  • autism symptoms and maladaptive behavior lower with older individuals
  • MR - more symptoms and maladaptive behavior
  • Lower problems with higher language ability
  • added gender into assessment
• Methods
  • sample
    • longitudinal study of 406 individuals with autism - 10 or older with a Dx on the autism spectrum
    • all had an ADI-R to confirm diagnosis
    • half in Wisconsin, half in MA
  • tested every 18 months - this article represents a 4.5 year period
  • 10-52 years of age at the beginning of the study
    • 1.7% living independently
    • 66.4% lived at home
    • 1/4 had siezure disorder
    • 74% had phrase speech
    • 68.5% had MR
  • measures
    • ADI-R
    • problem behavior scale of SIB-R
      • how often does problem behavir occur
      • what is the change in symptoms from time I to time 4?
    • MR - determined from
      • WRIT - verbal and nonverbal for half of the population
      • Vineland Screener
      • scores of 75 were classified as not having MR
        • also used reports and clinical records
      • scored as verbal or nonverbal
  • data analysis
    • paired t-test
    • standardized mean difference
    • distribution of change
    • multiple linear regression analysis
• Results
  • friendship impairment - most prevalent symptom
  • reciprocal conversation a problem
  • least prevalent
    • neologisms
    • pronoun reversal
    • use of other's body to communicate
  • 19 items improved, 13 stayed the same.  None regressed
  • improvements in
    • verbal communication
    • social reciprocity
    • repetitive behavior
  • no change in nonverbal communication
  • more people improved than those who regressed
  • predictors of autism symptoms
    • nonverbal communication
      • 31 or older
      • diagnosis of MR
    • verbal communication
      • MR
    • social reciprocity
      • MR
      • less language - more symptoms
    • repetitive behavior
      • 31 - fewer stereotypy
      • MR - more stereotypy
  • more MR - less improvement over time
  • language overall predicted improvement - especially social impairment
  • maladaptive behavior
    • most prevalent (Time I) - repetitive habits, withdrawal
    • least prevalent - distructive, aggression to others
    • decreased over observations
      • seemed to be visible
  • predictors of maladaptive behavior
    • for externalized behavior - MR
    • verbal - asocial maladaptive behavior
  • individuals with MR not as much improvement over time
• Discussion
  • more impairements in nonverbal communicaiton and social skills in older population
  • evidence of improvement and stability
    • stable - nonverbal communication and social
    • future research - what are the predictors of who gets better and who gets worse?
  • all scales - showed improvement over time
    • repetitive behaviors most prevalent in Early Childhood,  least prevalent in adulthood
  • seems that some symptoms tend to improve in early childhood and others in adulthood
  • could be the effects of interventions and medications
  • MUST KEEP A LIFESPAN PERSPECTIVE TO INTERVENTIION
  • older individuals improve
    • not supported for core autism symptoms
  • verbal skills - better prognosis for social reciprocity only
  • limitation - reliance on parental report
    • repeated measures - regression?
  • strengths
    • large cohort
    • community smample
    • more info on maladaptive behavior
  • treatement models less available for adults and adolescents
  • should be considered an endorsement for more research into treatments for adolescents and adults, not a reason to d/c services
    • people will not spontaneously recover!
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